Is this acceptable?
I saw an old question were a blank was ruled unacceptable, however I have the information only it is in a different format.
In accordance with FAR 52.228-15, Payment and Performance Bonds - Construction, the contractor shall furnish Standard Form (SF) 25 for performance bonds and Standard Form 25A for Payment Bonds. The current Standard Form 25A is revision 8/2014. This revision of SF 25A does not contain a block for including the bond premium. The current Standard Form 25 is also revision 8/2014 and the SF 25 does contain a bond premium block for fill-in.
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Some bonds now have a graduated scale for bond costs as it appears your payment bond does. The rate chart you have should be sufficient for your purposes. If you have any concern with the validity of the rate chart, contact the bonding company for confirmation and document the contract file with the finding.